JUVENILE RHEUMATOID ARTHRITIS (JRA)

Overview & Facts

Juvenile rheumatoid arthritis is characterized by joint stiffness and inflammation of more than 6 weeks in a person 16 y/o or younger

Due to Inflammation, joints may manifest with:

Redness
Swelling
Warmth
Soreness in the joints
- Not all may complain of pain

It can affect any joint and may decrease functions of affected areas.

Types & Symptoms

	PAUCIARTICULAR	POLYARTICULAR	SYSTEMIC
# of Joints Involved	4 or less	5 or more	Small percent develop arthritis in many joints
Manifestations	Most common (50% of those with JRA) Affect Large joints (Ex. – Knees) Predisposed to eye disease like iritis (inflammation of the colored part of the eyes) or uveitis (inflammation of the inner eye) Can be outgrown by Adulthood	30% of those with JRA Commonly affects Small joints (Ex. – Hands & feet) Symmetrical (affects both sides of the body)	AKA “Still’s Disease (20% of childrin with JRA) Classic Signs: Joint Swelling Fever Light Pink Rash May affect: Heart Liver Spleen Lymph Nodes
Presence of Antibodies	(+) Anti-nuclear antibodies (ANAs)	(+) Rheumatoid Factor in some children (severe form of the disease)	May be (+) Anti-nuclear antibodies (ANAs)

Other Manifestations

Chronic fever
Anemia
Fevers of 103 F or higher
Pink rash that comes and goes
Limping
Being less active
Difficulty in activities involving the hand and fingers such as writing or coloring
Bone development and growth problems

It is often difficult to diagnose JRA due to the lack of complaints from the affected individual or obvious manifestations. Also, manifestations are similar to other conditions such as in infection, cancer, bone disorders, Lyme disease, and systemic lupus erythematosus.

Physician may do/request:

History & Physical Exam
- Ask questions about symptoms and Family medical history
- Look for swelling of joints, rashes, signs of internal organ inflamation or eye complications
Blood and joint fluid samples may also be requested
X-Ray and other tests to assess joint inflammation and damage

RECOMMENDED MEDICATIONS

Medications combined with exercise is the usual treatment regimen.

Goals of the treatment program are:

Inflammation reduction
Pain and swelling reduction
Joint strengthening and mobility
Prevention of further damage and other complications

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)	Reduction of pain, fever & inflammation Liquid or pill form, 1 to 4 times a day Ex. – Aspirin, ibuprofen, naproxen, and tolmetin Side effects – Stomach pain, vomiting, nausea, headache, and anemia
Disease-Modifying Antirheumatic Drugs (DMARDs)	Slows down or stops the course of the disease Aid with joint pain, stiffness & swelling Ex. – hydroxychloroquine (Plaquenil), methotrexate, and sulfasalazine (Azulfidine) Can be take from 3 to 6 months to be effective Side effects – Anemia, low blood count, and kidney, liver problems, stomachaches, diarrhea, vomiting, nausea, headaches, rashes, loss of appetite, and weakness.
Biologic Drugs	Genetically engineered to act on the immune system Ex. – adalimumab (Humira), anakinra (Kineret), etanercept (Enbrel), and infliximab (Remicade) Side effects – increase chances of infection such as tuberculosis Must be taken with strict physician supervision
Corticosteroids (Steroids)	Only prescribed as a last option if other treatments fail or if the disease is severe Come in liquid or pill form and are prescribed for short periods and in low doses; Those with only a single joint may get a steroid injection Ex. – dexamethasone, hydrocortisone, methylprednisolone, prednisolone, and prednisone. Side effects – stunted growth, ulcers, mood swings, weight gain, “moon face,” muscle weakness, high blood pressure, osteoporosis, cataracts, and infections.

JUVENILE RHEUMATOID ARTHRITIS (JRA)

Overview & Facts

Types & Symptoms

Diagnosis & Medications

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